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Updated: 4/10/2020

Giant Cell Tumor of Tendon

Sheath
Joshua Blomberg

. / )
6 /6 1 /1

Introduction

A benign nodular tumor that is found on the tendon

sheath of the hands and feet
Also known as pigmented villonodular tumor of the
tendon sheath (PVNTS)
Epidemiology
present in 3rd-5th decade of life
incidence
second most common soft-tissue tumor seen in the
hand, following ganglion cyst
location
it is most common on palmar surface of radial three
digits near DIPJ
no reports of metastisis in literature

Presentation

Symptoms
enlarging mass
pain, worse with activity (or wearing shoes, for foot
lesions)
Physical exam
firm, nodular mass that does not transilluminate
Differential diagnosis
ganglion cyst
cystic component
pigmented villonodular synovitis
histologically identical
involves larger joints
desmoid tumor
fibroma/fibrosarcoma
glomangioma

Imaging

Radiographs
pressure-type bone erosion can be seen in up to 5%
of patients on radiographs
Ultrasound
able to demonstrate relationship of lesion with
adjacent tendon
homogeneously hypoechoic, although some
heterogeneity may be seen in echo-texture in a
minority of cases
most have some internal vascularity
MRI
MRI may be helpful diagnostically
appearance of the focal form is generally decreased
signal intensity on both T1-and T2-weighted MR
imaging

Histology

Characterized by
proliferating histiocytes, moderately cellular (sheets
of rounded or polygonal cells)
hemosiderin (brown color) may be present, but
typically less than seen with PVNS
multinucleated giant cells are common

Treatment

Operative
marginal excision
5-50% recurrence rate
more common if tumor extends into joints and
deep to the volar plate
tendon involvement associated with high
recurrence rate
local recurrence is usually treated with repeat
excision
operative approach is dependant on location and
extent of the tumor

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